Bowel incontinence

Bowel incontinence

Bowel Incontinence: Prevalence and Causes

Bowel incontinence causes immeasurable shame and embarrassment among those who suffer from the condition. Loss of self-esteem, depression, and social isolation may occur. Because of the shame many patients experience, patients may suffer with this potentially treatable condition. The following article will examine the prevalence of the bowel incontinence in the general adult population and discuss some of the potential causes in both men and women.

Prevalence

It is difficult to determine the prevalence of bowel incontinence, as many people are too embarrassed to admit the problem to their doctor. Bowel incontinence is more common in women as a result of damage caused by childbirth, but the condition occurs in both sexes. Some studies have suggested that 1.4% of the adult population over the age of 40 have major bowel incontinence.

The National Institute of Health reported in 2007 that in women living in the community, bowel incontinence occurred in 6% of those younger than 40 years of age. The figure jumped to 15% in older women. In men, bowel incontinence was found to affect 6 to 10% of men living in the community. This figure increases slightly with age. In a study conducted in the U.S. of two nursing homes, there was a 45-47% prevalence of bowel incontinence among residents of the homes, and bowel incontinence was a contributing factor in their admission to the home. As mentioned previously, the prevalence of this condition is probably higher than most studies estimate. Many people who have the condition likely do not tell their doctors or seek help for the problem.

Causes

As in urinary incontinence, one or a combination of several contributing factors can cause bowel incontinence. A definition of bowel incontinence is the uncontrolled and involuntary passage of stool or flatus (gas).

Bowel continence requires that several complex signals work in harmony. Any conditions that interrupt these signals may result in bowel incontinence. The anal sphincters are two groups of muscles, the internal anal sphincter and the external anal sphincter, which control the opening of the anus. The puborectalis muscle acts as a sling keeping the rectum and the anal canal at right angles to each other, except during defecation. The colon and rectum are composed of smooth muscles that are supplied by nerves that provide sensation and contraction of these muscles.

Conditions that may cause or contribute to bowel incontinence include the following:

• Birth defects that may result in spinal cord damage (spina bifida, myelomeningocele)
• Damage to the anal sphincter (vaginal delivery, surgery, inflammatory conditions, cancer)
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Diabetes
• Stroke
• Spinal cord trauma
• Degenerative disorders of the nervous system (Multiple Sclerosis, amyotrophic lateral sclerosis)

Childbirth is the most common predisposing factor to bowel incontinence in women, and explains why women suffer from this condition more often than men. Childbirth may lead to damage to the internal and external anal sphincters. Damage can also occur to the pudendal nerve, which innervates the anal sphincters. The following childbirth scenarios put the patient at higher risk for damage to these structures:

• Third-degree tears of the vagina and rectum during delivery
• Successive vaginal deliveries if the patient had sustained prior damage to the anus
• Breech deliveries or other unusual fetal presentations
• Use of forceps in delivery
• Delivery of a large baby (weight greater than 4000 g)
• Episiotomy
• Prolonged labour

Studies have shown that advancing age also plays a role in the development of bowel incontinence. Aging appears to slow nerve conduction through the pudendal nerve, which may lead to decreased sensation or awareness of the urge to have a bowel movement. Additionally, pelvic floor muscles relax as a result of aging. Anal sphincter tone may also relax as we age.

Conditions affecting awareness such as dementia and Alzheimer’s can also lead to bowel incontinence, not for physical reasons but because these patients may lose the ability to be aware of when they need to have a bowel movement.

Functional bowel incontinence can also occur as a result of a decrease in mobility. Patients who are unable to ambulate by themselves or are dependant on others to help them to the bathroom may be incontinent simply because they have to wait too long.

Bowel incontinence is a condition that is probably much more common in adults than people imagine. Due to the embarrassment and shame that accompanies the condition, many people do not seek medical help for this problem. The condition is more common in women than in men due to the fact that childbirth can cause damage to muscles and nerves that are responsible for maintaining bowel continence. However, any condition that may affect the brain, nervous system, muscles of the colon and rectum, and sphincters of the anus may result in bowel incontinence.

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